I’m a 3 on the Norwood Scale for hair loss and considering hair transplant surgery. My doctor suggested I need 2500 grafts but he didn’t intend on going into my widow’s peak, which still has hair but is awfully thin (you can easily see the scalp). His reason is the possibility of shock loss, which is certainly something to be fearful of.

I’m happy to know he’s considerate of it and not just ready to jump in. But when I said I don’t think I should bother having hair restoration surgery done until I lose more hair, as I specifically want more hair in the peak, he said he’d be comfortable doing it after re-reviewing my photos. Kind of a flip, so not sure how to take that.

Is shock loss from hair transplants permanent or does it grow back? Is shock loss a handful of hairs here and there or whole areas? Any idea how likely?

Shock loss (postoperative telogen effluvium) is a phenomenon that really varies from practice to practice as well as from patient to patient and tends to affect women more than men. In our practice, we generally state that significant shock loss is seen after about 40-50% of female cases and 10-15% of male cases. When it happens, it occurs 2.5 to 3 weeks after a session, but grows back 2.5 to 3 months post-operatively. In an area that has been treated, 1 to 3 out of every 10 hairs may temporarily fall out before regrowing.

The greatest emphasis should be on creating the recipient pattern to avoid transection of existing hair. Now, that’s not to say areas of future hair loss (e.g. your widow’s peak) should be avoided. Quite the contrary, actually. It’s essential to treat the areas of future loss so that patients are never obligated to return for a follow-up session in order to simply make it look natural again. For example, not treating a tuft of hair in a patient’s central hairline would ultimately leave an unnatural bald patch after a patient has progressed with their normal course of androgenic alopecia (pattern balding). They would then have to return to treat that in order to simply look normal again.

The key is simply attention to detail and taking a good 2+ hours when designing the pattern in order to carefully navigate through areas with pre-existing hair that requires thickening. This enables the recipient sites to be carefully created at the exact same angle and direction of the pre-existing hairs (even if there are sudden changes, as seen in a cowlick). Rushing through this process, like an automatic sewing machine, increases traumatic follicle transection which may not always be temporary. Fortunately, the hair restoration physicians recommended on the Hair Transplant Network are great and don’t rush this process. But, as a patient, please don’t be afraid to ask your surgeon how long it takes them to create the recipient pattern.